Comprehensive Clinical Skills Checklist

Vital Signs
Blood Pressure (BP)
Back supported/Legs uncrossed
Arm supported at Heart level
Check cuff size
Place cuff on arm with artery mark over brachial artery
Inflate bladder rapidly
Deflate slowly
Check systolic by palpation first (radial or brachial artery)
Check by auscultation (bell of stethoscope)
Record readings within 2 mm Hg or torr

Done
Done
Done
Done
Done
Done
Done
Done
Done

Not
Not
Not
Not
Not
Not
Not
Not
Not

Done
Done
Done
Done
Done
Done
Done
Done
Done

Heart (Pulse) Rate (HR)

Palpate radial pulse
With fingers, not thumbs
Bilaterally, simultaneously
Count 30 seconds duration
Record a per minute rate
If pulse <50 or >100, palpate for 1 minute and record rate

Done
Done
Done
Done
Done
Done

Not
Not
Not
Not
Not
Not

Done
Done
Done
Done
Done
Done

Orthostatic or Postural Blood Pressure

Measure Blood Pressure Supine
Measure Heart Rate Supine
Measure Blood Pressure within 3 minutes of standing
Measure Heart Rate within 3 minutes of standing
Determines whether Orthostatic hypotension exists

Done
Done
Done
Done
Done

Not
Not
Not
Not
Not

Done
Done
Done
Done
Done

Respiratory Rate (RR)

Does not tell patient the RR is being counted
Count 30-60 seconds duration
Record a per-minute rate

Done
Done
Done

Not Done
Not Done
Not Done

BMI
Calculate or look at chart
Record BMI

Done
Done

Not Done
Not Done

Waist Circumference
Measure above the uppermost lateral border of the iliac crest
Horizontal plane to floor
Flexible measure
Record noting inches or centimeters

Done
Done
Done
Done

Not
Not
Not
Not

For Preceptors Office

Weight
Patient should wear light clothing, but no shoes
Patient on scales appropriately

Done
Done

Not Done
Not Done

Done
Done
Done
Done

Measure weight accurately

Record noting pounds or kilograms

Done
Done

Not Done
Not Done

Height
No shoes
Check hair style or head coverings
Measure accurately
Record noting inches or centimeters

Done
Done
Done
Done

Not
Not
Not
Not

Done
Done
Done
Done

Head, Eyes, and Neck Physical Examination Checklist I

HEAD
Inspection:
Hair
Scalp
Skull
Face
Skin
EYES
Inspection:
Conjunctiva (patient looks up while you depress both
lower lids with thumbs)
Sclera
Eyelids
Lacrimal apparatus
Eyebrows
Test visual acuity with Snellen card and Otoscope
Inspect size, shape and symmetry of pupils
Test pupillary reaction to light (direct reaction and
consensual reaction)
Test extraocular muscles
Cover-uncover
Normal conjugate movements
Assess for nystagmus
Assess for lid lag
Convergence
Ophthalmoscopic exam
Identify optic disc
Identify retinal vasculature

Done
Done
Done
Done
Done

Not
Not
Not
Not
Not

Done

Not Done

Done
Done
Done
Done

Not
Not
Not
Not

Done
Done

Not Done
Not Done

Done
Done
Done
Done
Done
Done

Not
Not
Not
Not
Not
Not

Done
Done
Done
Done
Done

Done
Done
Done
Done

Done
Done
Done
Done
Done
Done

Done

Not Done

NECK
Inspection:

Done

Not Done

Palpation of lymph nodes (Bilateral):

Finger tips
Rolling motion

Done
Done

Not Done
Not Done
2

Look at face if tenderness suspected

Preauricular
Postauricular
Occipital
Submental
Submandibular
Tonsillar
Anterior cervical
Posterior cervical
THYROID
Inspection:
Palpation:
Anterior approach
Asked patient to swallow
Posterior approach
Asked patient to swallow

Done
Done
Done
Done
Done
Done
Done
Done
Done

Not
Not
Not
Not
Not
Not
Not
Not
Not

Done
Done
Done
Done
Done
Done
Done
Done
Done

Done

Not Done

Done
Done
Done
Done

Not
Not
Not
Not

Done
Done
Done
Done

Ears, Nose, Throat Physical Examination Checklist II

EARS
External examination
Inspection:
Palpation (Bilateral)
Pull pinna
Press tragus
Press posterior auricular area
Auditory acuity testing (Bilateral):
Whisper
Rinne Test
Webber Test
Otoscopic examination
Inspection Bilateral:
Pull pinna up, out, and back
Speculum inserted in external canal
Done
NOSE
External examination
Palpation (Bilateral)
Each nostril patent
Frontal sinuses
Maxillary sinuses
Internal examination
Inspection (Bilateral):
Head held back
Tip of patients nose elevated with thumb
Illumination

Done

Not Done

Done

Not Done
Done
Not Done
Done
Not Done

Done
Done

Not Done
Not Done
Done
Not Done
Done
Done

Done
Done
Done

Not Done
Not

Not Done
Not Done
Not Done

Done

Not Done
Not Done
Done
Not Done
Done
Not Done
Done

ORAL CAVITY AND PHARYNX

Inspection:
Mouth open widely
Illumination in one hand
Tongue out
Tongue up
Say ah!
Tongue blade in one hand
Pull cheeks away from gums
Middle third of tongue depressed

Done

Not Done
Not
Not
Done
Not Done
Done
Not Done
Done
Not Done
Done
Not
Done
Not
Done
Not
Done
Done

Done
Done

Done
Done
Done

Cardiac and Peripheral Vascular Examination Checklist

Vital signs
Check blood pressure
Check radial pulse rate and rhythm
Assessing central venous pressure
General appearance
Nail beds for clubbing, splinter hemorrhages, etc.
Shamroths sign
Jugular veins for distention (may attempt to
measure)
Auscultation of Carotid Arteries
Auscultate Carotid arteries
Asks patient to hold breath when auscultating
Prior to palpation (If bruit present, do not palpate)
Palpation of Neck
Carotid arteries
One at a time
Low in the neck (not over carotid bulb)
Palpation of Heart for Thrills, Heaves, and Lifts
Feel for thrills, heaves, and lifts with finger pads
Observe for heaves and lifts with ball of hand
2ICS-RSB Aortic Area
2ICS-LSB- Pulmonic Area
Right ventricular area- Left sternal border
Epigastric (subxiphoid)
Left ventricular area Apex
PMI
Finger tips
Appropriate area (normal 5ICS-MCL)
Auscultation of Heart
Eliminate extraneous noise
Ear piece correctly placed in ears
Bell lightly placed on skin
Diaphragm firmly placed on skin

Done
Done

Not Done
Not Done

Done
Done
Done
Done

Not
Not
Not
Not

Done
Done
Done

Not Done
Not Done
Not Done

Done
Done
Done

Not Done
Not Done
Not Done

Done
Done
Done
Done
Done
Done
Done

Not
Not
Not
Not
Not
Not
Not

Done
Done

Not Done
Not Done

Done
Done
Done
Done

Not
Not
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Not

Done
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Done
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Done
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Done
4

Stethoscope on bare skin

Supine Diaphragm
2ICS-RSB Aortic area
2ICS-LSB Pulmonic area
3ICS LSB - Erbs point
4ICS LSB Tricuspid area
5ICS LSB - Tricuspid area
5ICS-MCL Mitral area
Supine bell
Left Lateral Decubitus Bell in 5ICS-MCL Mitral
valve
Upright Diaphragm
2ICS-RSB Aortic area
2ICS-LSB - Pulmonic
area
3ICS LSB - Erbs point
4ICS LSB Tricuspid area
5ICS LSB - Tricuspid area
5ICS-MCL Mitral area
Upright leading forward at Apex
PERIPHERAL VASCULAR SYSTEM
Inspection
Symmetry of extremities
Color of extremities
Warmth of extremities
Varicosities (The patient is standing)
Palpation
Pulsesbilateral
(radial, brachial, femoral, popliteal, dorsalis pedis,
posterior tibial)
Dependent areas for pitting edema shin or sacral area

Done

Not Done

Done
Done
Done
Done
Done
Done

Not
Not
Not
Not
Not
Not

Done

Not Done

Done
Done
Done
Done
Done
Done
Done
Done

Not
Not
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Not
Not
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Not

Done
Done
Done
Done
Done
Done
Done
Done

Done
Done
Done
Done

Not
Not
Not
Not

Done
Done
Done
Done

Done

Not Done

Done

Not Done

Done
Done
Done
Done
Done
Done

Peripheral Vascular Checklist

Neck (will be covered in cardiovascular block)
Auscultate for carotid bruits
Palpate for thrills/bruit
Upper extremity
Inspect both arms from fingertips to shoulder
Size
Symmetry
Edema
Venous pattern
Color of skin/nail beds
Skin texture
Palpate epitrochlear nodes
Palpate bilateral pulses
Brachial

Done

Not Done
Not Done

Done

Done

Done

Not
Not Done
Not Done
Done
Not
Done
Not Done
Done
Not Done
Done
Not
Done
Not
Done
Not Done
Done
Not Done
Done
Done

Done
Done
Done

Radial
Ulnar
Grade amplitude of arterial pulses
Measure blood pressure in both arms

Done

Not Done
Done
Not Done
Done
Not Done
Done
Not Done

Abdomen (will be covered in abdominal Clinical Skills)

Auscultate for aortic bruit
Auscultate for renal bruit
Auscultate for femoral bruit
Palpate abdominal aorta in epigastrium
Estimate width of abdominal aorta in epigastrium
Done
Lower extremities
Inspect both legs from groin and buttocks to feet
Done
Leg size
Done
Symmetry
Done
Edema
Evaluate venous pattern/venous enlargement
Evaluate pigmentation, rashes, scars or ulcers
Examine skin color and texture
Examine nail bed color
Done
Examine hair distribution on lower legs, feet, and toes
Done
Examine for skin ulceration
Examine trophic changes or nail abnormalities
Note temperature of feet and legs with back of fingers
Not Done
Inspect inguinal lymph nodes for lymphadenopathy

Done
Done
Done
Done

Done
Done
Done
Done

Not
Not
Not
Not
Done

Done
Done
Done
Done
Not

Done

Not

Not Done
Not Done
Not
Not
Not
Not
Not Done
Done

Done
Done
Done
Done
Not

Done
Done

Not Done
Not Done
Done

Done

Not Done

Lower extremity pulses

Palpate/grade bilateral pulses
Done
Not Done
Femoral
Done
Not Done
Popliteal
Done
Not Done
Dorsalis pedis
Done
Not Done
Posterior tibialis
Done
Not Done
Note temperature of feet and legs with back of fingers
Done
Not
Done
Check for pedal (foot) swelling
Pedal edema
Pitting edema
If pitting edema, grade severity on 4 point scale

Done
Done
Done

Not Done
Not Done
Not Done
Done
Not

Done
If pitting edema, measure legs with tape measure

Done

Not

Done
Forefoot
Ankle

Done
Done

Not Done
Not Done
6

Calf
Done
Mid-thigh
Done
Patient stands to inspect saphenous veins for varicosities

Not Done
Not Done
Done

Not

Not Done
Done

Not

Done

Not

Done
Special techniques
Allen test
Done
Postural color changes of chronic arterial insufficiency
Done
Trendelenberg test (evaluate for venous retrograde filling)
Done

Chest Examination Checklist

General Inspection:
The chest wall
Inspection of fingers (for clubbing)
Posterior Chest (The patient should be sitting)
Inspect, Palpate, Percuss, Auscultate
Posterior Chest Inspection (Gown open in back)
Symmetry of Chest expansion
Tactile fremitus (Palpation)
Palpate/patient says 99
Side-to-side with full hand contact
4 positions bilaterally
Percussion
Wrist action (one finger touching only; not whole
hand)
Side-to-side
7 positions bilaterally
Auscultation
On bare skin
Diaphragm of stethoscope
Patient breathes through mouth
7 positions bilaterally
Anterior Chest Inspection (The patient may be
repositioned supine)
Inspect, palpate, percuss, auscultate
Inspection
Uses the gown to drape patient accordingly
Palpate position of trachea
Palpation: Tactile fremitus
Side-to-side
3 positions bilaterally
Percussion
Wrist action technique

Done
Done
Done

Not Done
Not Done
Not Done

Done

Not Done

Done
Done
Done

Not Done
Not Done
Not Done

Done

Not Done

Done
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Not Done
Not Done

Done
Done
Done
Done

Not
Not
Not
Not

Done
Done

Not Done
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Done
Done

Not Done
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Done

Not Done

Done
Done
Done
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Side-to-side
Done
Not Done
6 positions
Done
Not Done
Auscultation
On bare skin with diaphragm
Done
Not Done
Side-to-side
Done
Not Done
6 positions
Done
Not Done
If time, discuss and demonstrate:
Egophony (E to A changes seen in pneumonia or consolidative processes)
Whispered pectoriloquy (Whisper 99; should hear faintly or not at all)
Abdominal Examination Checklist
The patient is supine (pull out leg rest for patient
comfort)
Inspection
Arranges sheet and gown to expose abdomen
Inspects the abdomen
Asks patient to identify areas of pain
Auscultation
Auscultates with diaphragm of stethoscope
Auscultates prior to palpation
Auscultates for bowel sounds
Auscultates for bruits (renal, iliac, femoral)
Light Palpation
Palpates point of maximal tenderness last.
One hand
Fingers together
All quadrants
Looks at patients face
Deep Palpation
Two hands
All quadrants
Looks at patients face
Organ Palpation
Liver area (feel liver under fingers with inspiration;
hooking)
Spleen area
Aorta
Percussion
Percusses four quadrants
Percusses liver span
Measures liver span
Rebound Tenderness
Check at point away from maximal tenderness
In slowly and deeply, then release quickly
Appropriate verbal cues
CVA
Reposition patient to sitting position
Gently hit with fist

Done

Not Done

Done
Done
Done

Not Done
Not Done
Not Done

Done
Done
Done
Done

Not
Not
Not
Not

Done
Done
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Done
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Not
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Done
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8

Bilaterally
Renal area
Special assessment techniques
Test for shifting dullness
Test for fluid wave
Assessing appendicitis
Identify McBurneys point
Rovsings sign
Psoas sign
Obturator sign
Assessing cholangitis
Murphys sign
Assessing ventral hernias
Ventral and umbilical

Done
Done

Not Done
Not Done

Done
Done

Not Done
Not Done

Done
Done
Done
Done

Not
Not
Not
Not

Done

Not Done

Done

Not Done

Done
Done
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Done

Musculoskeletal Exam
TEMPOROMANDIBULAR
Inspection
Look for asymmetry and swelling
Palpation
Areas of tenderness, dislocation, crepitus
Range of Motion
Open and Closing of jaw
Protrusion and Retraction of jaw
Side to Side motion of jaw
SHOULDER both shoulders must be examined. Patient may be sitting or standing
Inspection
Look for deformity, wasting, swelling, asymmetry.
Evaluate posterior and anterior
Palpation for local areas of tenderness
Bilateral
Bony
Clavicle medial to lateral
Acromion
Spine and edge of scapula
Proximal humerus
Soft tissue
Biceps tendon
Muscles
Supraspinatus, Infraspinatus, Teres minor
Range of Motion
Bilateral
Active and Passive
Abduction 180
Adduction 45
9

Flexion 90
Extension 45
Internal rotation 55
External rotation 40
Maneuvers for Rotator Cuff Injuries
Apley Scratch test
Drop Arm
Empty Can
Lift off- Painful arc
Speed test
Neer Impingement
Hawkins Impingement

ELBOW
Inspection
Look for nodules, swelling, deformities
Palpation for local areas of tenderness
Bilateral
Bony: Olecranon process and epidcondyles
Range of Motion
Active and Passive
Flexion
Extension
Pronation
Supination
WRIST and HANDS
Inspection
Look for swelling, nodules, deformities, radial or ulnar deviation, or contractures
Palpation
Wrist
Metacarpal joints
Proximal Interphalangeal joints
Distal Interphalangeal joints
Range of Motion
Wrist
Active and Passive
Flexion 90
Extension 90
Adduction 20
Abduction 20
Fingers
Active and Passive
Flexion make a fist
Extension
Adduction
10

Abduction
Thumb
Active and Passive
Flexion
Extension
Abduction/Adduction
Opposition
Maneuvers for Carpel Tunnel
Test Thumb Abduction
Tinels sign
Phalens sign
SPINE
Inspection
Look for curvature and posture
Palpation
Each spinous process
Paravertebral muscles
Range of Motion
Neck Active and Passive
Flexion
Extension
Rotation
Lateral Bending
Back Active
Flexion
Extension
Rotation
Lateral Bending
Maneuvers
Straight Leg Raise
Kernigs sign
HIP
Inspection of Gait
Palpation
Iliac Crest, Iliac Tubercle, and Greater Trochanter
Range of Motion
Active and Passive
Flexion
Extension
Abduction
Adduction
External Rotation
Internal Rotation
KNEE both knees must be examined. Patient sitting and then supine
Inspection bilateral
Look for symmetry, alignment, patellar location, swelling, and warmth Standing and
11

Sitting
Palpation bilateral
Bony
Proximal tibia
Proximal fibula
Distal femur
Patella
Soft tissue
Medial joint line
Lateral joint line
Parapatellar soft tissue
Range of Motion bilateral
Active and Passive
Flexion 135
Extension 0
Internal rotation 10
External rotation 10
Maneuvers
Bulge Sign for effusions
Balloon Sign
Joint Stability bilateral
Collateral ligaments - Medial and Lateral
Cruciate ligaments Drawer Sign
Anterior
Posterior
Lachmann
McMurray
Valgus strain- abduction of knee
Varus Strain
ANKLE AND FOOT
Inspection
Looking for any deformities, nodules, swelling, calluses, or corns
Palpation
Anterior aspect of ankle joint
Along Achilles tendon
Heel - inferior and posterior calcaneus
Planter fascia
Medial and lateral malleolus
Metatarsophalangeal joints and heads of metatarsals
Range of Motion
Active and Passive
Plantar flexion
Dorsiflexion
Inversion
Eversion
Neurological Physical Examination Checklist:
12

 Cranial Nerves
Identify scents, olfactory (I)
Visual acuity (II)
Visual Fields (II)
Ocular Fundi (II)
Pupillary constriction (III)
Extra ocular movements (EOM) (III, IV, VI)
Up and down
Laterally and medially
Oblique
Pupillary accommodation (III)
Corneal reflex (V, VII) not tested on SPs or students
Sensory of the face (V)
Above and below the eyes
and side of mouth
Bilaterally
Mastication (bite down) (V)
Facial expression (VII)
Eyes closed tightly
Raise eyebrows
Smile
Puffy cheeks
Identify whispered word (VIII)
Weber, Rinne (VIII)
Gag (IX)
Use Say Ah method for each other and all S Ps
Turn head against resistance (XI)
Bilaterally
Shoulder Shrug (XI)
Tongue movement (XII)
Motor Function
Strength -Graded 0-5 tested with resistance
Upper extremity, bilaterally
Flexion at elbow
Extension at elbow
Flexion of wrist
Hand grip
Adduction/abduction of fingers
Thumb adduction
Lower extremity, bilaterally
Hip flexion
Knee flexion
Knee extension
Ankle dorsiflexion
Ankle plantar flexion
Great toe dorsiflexion
Great toe plantar flexion
Tone
Upper extremity
Lower extremity

Please circle one:

Done
Not
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(IX, X)
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13

Bilaterally
Deep Tendon Reflexes (DTR) 0- 4+ scale
Normal reflexes Each of the following bilaterally:
Mandibular (not in Swartz)
Biceps
Triceps
Brachioradialis
Patella
Achilles
Abnormal reflexes
Babinski
Chaddocks (optional)
Oppenheims (optional)
Sensory Function (feels the same bilaterally)
Pain
Sharp or dull
Distally to proximally
Bilaterally
Upper and lower extremities
Temperature
Distally to proximally
Bilaterally
Upper and lower extremities
Light Touch
Bilaterally
Vibratory
Distally to proximally
Bilaterally
Upper and lower extremities
Proprioreception
Fingers
Toes
Hold laterally
Bilaterally
Tactile localization
Double simultaneous stimulation X 2
Graphesthesia
Numbers on palms
Bilaterally
Right side up for patient
Cerebellar Function
Finger to nose
Bilaterally
Heel to Shin
Move heel distally
Bilaterally
Rapid alternating movements
Pronate/supinate
Thumb to fingers

Done

Not Done

Done
Done
Done
Done
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Not
Not
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Not

Done
Done
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Not Done
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Done
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Done
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Done

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14

Bilaterally
Romberg
Pronator Drift
Gait
Regular
Toe walk
Heel walk
Tandem

Done
Done
Done

Not Done
Not Done
Not Done

Done
Done
Done
Done

Not
Not
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Not

Done
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15